Utility of Fluorescent in situ Hybridization in Addition to Voided Urine Cytology in The Diagnostic Work Up of Bladder Cancer Patients: A Pilot Study from A South Indian Referral Laboratory

Abstract

Bladder cancer (BC) is one of the most common cancers in the world with a male predominance [1,2]. In the Indian scenario, it is amongst the most prevalent cancers associated with urinary tract and accounts for 3.9% of total cancer cases diagnosed according to the Indian cancer registry [3,4]. 3 males and 1 female out of 1,00,000 individuals develop BC each year in India [4-6]. Microscopic and macroscopic haematuria are the most common clinical manifestation of this disease [7]. Currently, the established techniques for diagnosing and monitoring BCs are cystoscopy and Voided Urine Cytology (VUC). Cystoscopy is regarded as the gold standard for detection of BC. VUC has been the front runner in urine-based assays for detection of BC’s for more than 50 years, owing to its low false positive rate (high specificity) and simplicity in testing. The sensitivity and specificity in detecting BC’s increases significantly when these two tests are coupled. Although cystoscopy is considered as gold standard, its sensitivity in detecting flat lesions is relatively low. VUC falls short due to high rate of false negative and equivocal diagnosis or Atypical Urine Cytology (AUC) [8]. Inter observer, intra observer and institutional variability have been serious technical facets of cytology [9]. As a disease characterised by long follow up surveillance with multiple diagnostic procedures, BC has significant financial implication while repetitive invasive procedures cause undue anxiety to patients.